Radiation Oncology, Chulolongkorn University : Low dose Preoperative Irradiation

Radiation Oncology Chulolongkorn University

Low dose Preoperative Irradiation

¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ã¹¢¹Ò´·ÕèàÃÕÂ¡¡Ñ¹ÇèÒ "Low dose" ¤×Í¡ÒÃãªé»ÃÔÁÒ³ÃÑ§ÊÕÃÇÁ
·Ñé§ËÁ´¹éÍÂ¡ÇèÒ 30 Gy «Öè§ã¹ÃÐÂÐàÃÔèÁáÃ¡¢Í§¡ÒÃãªé preoperative radiation ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËè
ÊèÇ¹ rectum ¹Ñé¹ àÃÔèÁ¨Ò¡¡ÒÃãªé»ÃÔÁÒ³ÃÑ§ÊÕ·Õè¤èÍ¹¢éÒ§µèÓ (<30 Gy) àªè¹ ¨Ò¡¡ÒÃÈÖ¡ÉÒÂéÍ¹ËÅÑ§¢Í§
Memorial Sloan Kettering Hospital1 µÑé§áµè»Õ ¤.È.1939 ¶Ö§»Õ ¤.È. 1951 ¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·Õè©ÒÂÃÑ§ÊÕáºº preoperative radiation ´éÇÂ»ÃÔÁÒ³ÃÑ§ÊÕ 2,000 cGy ã¹ 1 ÊÑ»´ÒËì áÅéÇµÒÁ´éÇÂ
¡ÒÃ·Ó¼èÒµÑ´ ¾ºÇèÒ¨ÐÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »ÕáÅÐ 10 »Õ ´Õ¡ÇèÒàÁ×èÍà·ÕÂº¡Ñº¡ÒÃ·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ
(43% vs 27%) ¨Ò¡¼Å¡ÒÃÈÖ¡ÉÒ¹Õéà»ç¹àËµØ·ÓãËéÁÕ¡ÒÃÈÖ¡ÉÒà¾ÔèÁàµÔÁ áºº randomized trial ·Õè Memorial Sloan Kettering Cancer Center (MSKCC)2 ã¹ÃÐÂÐàÇÅÒµèÍÁÒ â´Â¡ÒÃãªé preoperative radiation ´éÇÂ»ÃÔÁÒ³ÃÑ§ÊÕ·Õèà·èÒ¡Ñ¹ (2,000 cGy ã¹ 1 ÊÑ»´ÒËì) áµè¼Å·Õèä´é¡ÅÑº»ÃÒ¡¯ÇèÒ ¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´äÁèä´é»ÃÐâÂª¹ì·Õè´Õ¢Öé¹¡ÇèÒ¡ÒÃ·Ó¼èÒµÑ´à¾ÕÂ§ÍÂèÒ§à´ÕÂÇ â´ÂÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ à·èÒ¡Ñº 52% áÅÐ 59% µÒÁÅÓ´Ñº
Randomized trial ·Õè¹èÒÊ¹ã¨ÍÕ¡ÍÑ¹·ÕèÈÖ¡ÉÒ¨Ò¡ The Veteran’s Administration Surgical
Adjuvant Group (VASAG)3 ä´éÃÇºÃÇÁ¼Ùé»èÇÂ¨Ó¹Ç¹¶Ö§ 700 ÃÒÂ ·Õèà»ç¹ adenocarcinoma ¢Í§ rectum
áÅÐ rectosigmoid colon â´Âáºè§¼Ùé»èÇÂà»ç¹ 2 ¡ÅØèÁ¤×Í ¡ÅØèÁ·Õè·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇáÅÐ¡ÅØèÁ·ÕèãËé preoperative irradiation â´ÂãËé»ÃÔÁÒ³ÃÑ§ÊÕ·ÕèÍØé§ àªÔ§¡ÃÒ¹ 2,000 cGy ã¹ÃÐÂÐàÇÅÒ 2 ÊÑ»´ÒËì áÅéÇµÒÁ´éÇÂ¡ÒÃ·Ó¼èÒµÑ´ ¾ºÇèÒÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ ¹Ñé¹äÁèáµ¡µèÒ§¡Ñ¹ (38.8% áÅÐ 48.5%)
¹Í¡¨Ò¡¹Õé¡çÁÕ¡ÒÃÈÖ¡ÉÒ¢Í§ The Medical Research Council (MRC) ¨Ò¡»ÃÐà·ÈÍÑ§¡ÄÉ4 â´Â¡ÒÃãªé low dose preoperative radiation «Öè§áºè§¼Ùé»èÇÂÍÍ¡à»ç¹ 3 ¡ÅØèÁ ¤×Í ¡ÅØèÁ·Õè 1 ãËé»ÃÔÁÒ³ÃÑ§ÊÕ
500 cGy ¤ÃÑé§à´ÕÂÇ ¡ÅØèÁ·Õè 2 ãËé»ÃÔÁÒ³ÃÑ§ÊÕ¡èÍ¹·Ó¼èÒµÑ´ 2,000 cGy ã¹ 2 ÊÑ»´ÒËì áÅÐ¡ÅØèÁ·Õè 3 ·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ ¨Ò¡¡ÒÃÈÖ¡ÉÒ¹Õé¡çàªè¹à´ÕÂÇ¡Ñ¹ ¤×ÍäÁè¾ºÇèÒÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè´Õ¢Öé¹¡ÇèÒ¡ÒÃ·Ó¼èÒµÑ´à¾ÕÂ§ÍÂèÒ§à´ÕÂÇ ÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ 42%, 40 áÅÐ 38% µÒÁÅÓ´Ñº
µÒÃÒ§·Õè 3 áÊ´§¼Å¡ÒÃÈÖ¡ÉÒ¡ÒÃãªé low dose preoperative radiation ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹
rectum áÅÐ rectosigmoid «Öè§¨Ò¡¡ÒÃÈÖ¡ÉÒµèÒ§ æ ¾Í¨ÐÊÃØ»ã¹¢³Ð¹Õéä´éÇèÒ ¡ÒÃãªé low dose preoperative radiation ¹Ñé¹ ÊÒÁÒÃ¶Å´ÍØºÑµÔ¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤à©¾ÒÐ·ÕèÅ§ä´éà¾ÕÂ§àÅç¡¹éÍÂ áµèäÁè¾ºÇèÒ¨ÐÁÕ»ÃÐâÂª¹ìã¹á§è¢Í§¡ÒÃà¾ÔèÁÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂ ´Ñ§¹Ñé¹¨Ö§äÁèá¹Ð¹ÓãËéãªéà»ç¹ routine
management ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum

µÒÃÒ§·Õè 3 Rectal cancer : Results of Low - Dose Preoperative Radiation

Randomized study	Dose(cGy)	5-yr survival RT(%)	5-yr survival Surgery(%)
Rider(5)	500	39	35
MRC(4)	500	42	38
	2000	40	38
Sterns et al(MSKCC(2))	2000	52	59
Roswit et al(3)	2500	40	32
Stockholm Trial(6)	2500	40	45

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Last modified on 25 October 1996